TITLE

Advantages of Laparoscopic Appendectomy in the Elderly

AUTHOR(S)
Harrell, Andrew G.; Lincourt, Amy E.; Novitsky, Yuri W.; Rosen, Michael J.; Kuwada, Timothy S.; Kercher, Kent W.; Sing, Ronald E.; Heniford, B. Todd
PUB. DATE
June 2006
SOURCE
American Surgeon;Jun2006, Vol. 72 Issue 6, p474
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Laparoscopic appendectomy (LA) has gained in popularity in recent years. The number of elderly patients undergoing appendectomy has increased as that segment of the population has increased in number; however, the utility and benefits of LA in the elderly population are not well established. We hypothesized that LA in the elderly has distinctive advantages in perioperative outcomes over open appendectomy (OA). We queried the 1997 to 2003 North Carolina Hospital Association Patient Data System for all patients with the primary ICD-9 procedure code for OA and LA. Patients >65 years of age (elderly) were identified and reviewed. Outcomes including length of stay (LOS), charges, complications, discharge location, and mortality were compared between the groups. There were 29,244 appendectomies performed in adult patients (>18 years old) with 2,722 of these in the elderly. The annual percentage of LA performed in the elderly increased from 1997 to 2003 (11.9-26.9%, P < 0.0001). When compared with OA, elderly patients undergoing LA had a shorter LOS (4.6 vs 7.3 days, P = 0.0001), a higher rate of discharge to home (91.4 vs 78.9%, P = 0.0001) as opposed to a step-down facility, fewer complications (13.0 vs 22.4%, P = 0.0001), and a lower mortality rate (0.4 vs 2.1%, P = 0.007). When LA was compared with OA in elderly patients with perforated appendicitis, LA resulted in a shorter LOS (6.8 vs 9.0 days, P = 0.0001), a higher rate of discharge to home (86.6 vs 70.9%, P = 0.0001), but equivalent total charges ($22,334 vs $23,855, P = 0.93) and mortality (1.0 vs 2.98%, P = 0.10). When elderly patients that underwent LA were compared with adult patients (18-64 years old), they had higher total charges ($16,670 vs $11,160, P = 0.0001) but equivalent mortality (0.37 vs 0.15%, P = 0.20). The use of laparoscopy in the elderly has significantly increased in recent years. In general, the safety and efficacy of LA is demonstrated by a reduction in mortality, complications, and LOS when compared with OA. The laparoscopic approach to the perforated appendix in the elderly patient has advantages over OA in terms of decreased LOS and a higher rate of discharge to home as opposed to rehabilitation centers, nursing homes, or skilled nursing care. When compared with all younger adults, the laparoscopic approach in the elderly was associated with equal mortality rates even though hospitalization charges were higher. Laparoscopy may be the preferred approach in elderly patients who require appendectomy.
ACCESSION #
21356108

 

Related Articles

  • Laparoscopic appendectomy by residents: evaluating outcomes and learning curve. Yap Yan Lin; Shabbir, Asim; So, Jimmy B. Y. // Surgical Endoscopy;Jan2010, Vol. 24 Issue 1, p125 

    Laparoscopic appendectomy is being performed increasingly, worldwide. To the resident, it provides a valuable opportunity to master basic laparoscopic skills. Studies have shown that laparoscopic appendectomy performed by residents is safe. However, to date, there is no clear evidence for the...

  • Soft-tissue case 44. Diagnosis.  // Canadian Journal of Surgery;Apr2002, Vol. 45 Issue 2, p154 

    Investigates the epiploic appendagitis of an appendix epiploica. Characteristic of epiploic appendagitis; Use of ligation and surgical excision for the treatment of primary epiploic appendagitis; Use of computed tomography in the study.

  • Implications of Removing a Normal Appendix. Bijnen, C. L.; Van den Broek, W. T.; Bijnen, A. B.; De Ruiter, P.; Gouma, D. J. // Digestive Surgery;2003, Vol. 20 Issue 2, p115 

    Background: The diagnosis of acute appendicitis remains difficult, and therefore 15-30% of the removed appendices appear to be normal. The aim of this study is to investigate the morbidity, mortality and costs of removing a normal appendix in patients with suspected appendicitis. Patients and...

  • Video-Assisted Transumbilical Meckel's Diverticulectomy in Children. Clark, Jason M.; Koontz, Curt S.; Smith, Lisa A.; Kelley, Joseph E. // American Surgeon;Apr2008, Vol. 74 Issue 4, p327 

    The treatment of Meckel's diverticulum (MD) in children is resection. Some data exist for the use of laparoscopic resection. The Video-Assisted Transumbilical (VAT) single-trocar technique has been recently described for appendectomy. We also have used this technique for the resection of MD. The...

  • Laparoscopic splenectomy in the elderly: a morbid procedure? Kavic, S.; Segan, R.; Park, A.; Kavic, S M; Segan, R D; Park, A E // Surgical Endoscopy;Dec2005, Vol. 19 Issue 12, p1561 

    Background: Laparoscopic splenectomy has emerged as the gold standard for elective splenectomy. Few reports have critically evaluated the results of laparoscopic splenectomy in elderly patients.Methods: All laparoscopic splenectomies performed between August 19, 1998...

  • Torsion of Epiploic Appendage Mimic Acute Appendicitis. Pogorelić, Zenon; Stipić, Radoslav; Družijanić, Nikica; Perko, Zdravko; Grandić, Leo; Vilović, Katarina; Mrklić, Ivana; Jurić, Ivo; Boschi, Vladimir; Bekavac, Josip // Collegium Antropologicum;Dec2011, Vol. 35 Issue 4, p1299 

    Epiploic appendagitis is a rare cause of focal abdominal pain which, depending on its localisation, can mimic a variety of abdominal diseases. We report a case of 36-year-old woman who presented with a classic signs of acute appendicitis. On examination, the obese, afebrile, and had very strong...

  • Single-incision laparoscopic appendectomy versus traditional three-port laparoscopic appendectomy: an analysis of outcomes at a single institution. Buckley, F.; Vassaur, Hannah; Monsivais, Sharon; Jupiter, Daniel; Watson, Rob; Eckford, John // Surgical Endoscopy;Feb2014, Vol. 28 Issue 2, p626 

    Background: Questions have emerged as to whether single-incision laparoscopy has reproducible or superior patient outcomes compared with traditional laparoscopy. A retrospective review comparing single-incision laparoscopic (SILS) appendectomy and traditional multiport laparoscopic (MP)...

  • A brief review of laparoscopic appendectomy: the issues and the evidence. Vettoretto, N.; Agresta, F. // Techniques in Coloproctology;Mar2011, Vol. 15 Issue 1, p1 

    Laparoscopic appendectomy was first performed more than 25 years ago. We performed a systematic literature search on laparoscopic appendectomy and selected related topics. The technique should be considered the gold standard for surgical removal of the appendix in women of childbearing age...

  • Registered nurses' understanding of truth-telling as practiced in the nursing-home: An Australian perspective. Tuckett, Anthony G // Health Sociology Review;Jun2006, Vol. 15 Issue 2, p179 

    This article draws on an Australian research study using multiple qualitative methods to investigate 'truth-telling' in aged-care. Registered nurses understand truth-telling to be an instrumental practice in which information should be used as a means to avoid harm. The worth of truthfulness is...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics